What expectations do I have before I go to the doctor’s?

We have expectations before every visit to the doctor. We should be aware of these - because they influence the outcome of the treatment

Every patient has expectations, oscillating between hope and fear. The extent to which these expectations are positive or negative is largely shaped by the past experiences we remember.

There are many reasons why someone might visit the doctor, and patients bring with them a diverse range of expectations. Perhaps you just need a quick prescription and don’t expect to have to wait for long. You might assume that the doctor will let you tell him or her your whole medical history and then examine you from head to toe. You might just want some reassurance, or maybe you want to be informed about every detail of your diagnosis. And of course, everyone expects the appointment to be helpful and to alleviate their symptoms. We always have expectations, as we do in any other area of life – in the supermarket you expect to find your favourite yoghurt, which you’ve bought there many times before. Most of the time, though, we are not particularly aware of these expectations, and this is similar when you visit the doctor.

While wishes may also encompass unrealistic goals, expectations should be based on something that is genuinely possible. For example, if you assume that a single injection will make your weeks of back pain disappear forever, this may be a rather unrealistic expectation.

You’d be right to expect some fairly matter-of-fact things in a doctor’s practice:

• People who have an appointment expect not to have to wait for hours.
• Patients expect to be treated in a friendly and respectful manner by the practice staff.
• Patients can expect the doctor to give them their full attention in the consulting room.
• Patients can expect competence and expertise in terms of alleviating their symptoms.

Patients' expectations of their visit to the doctor are often complex, with some dimensions that are not especially evident. Above all, they are shaped and characterized by a variety of things:

• They are based on our past experiences with doctors, on our general attitudes towards medical procedures, and also on our individual personality.
• The experiences of close friends or family, and things they’ve told us, also play a role in our expectations before we visit the doctor.
• And then, of course, we read and hear about symptoms, treatments and side effects in the media and on the internet.

Our brain processes all of this information and links it to our memories. For example, you may have moved to another city and find that your new doctor is wearing the same distinctive red glasses as the doctor you saw in the emergency room two years ago, when your back pain had become unbearable. If the ER doctor helped you and you remember that you liked her, it is quite possible that you will also have a positive attitude towards the new doctor. Our expectations can sometimes be influenced by such – seemingly insignificant – details, without us being consciously aware of it.

Some expectations we are barely aware of. For instance, we’re unlikely to be able to give concrete reasons why we spontaneously perceive a doctor to be untrustworthy. We don’t realise that it’s perhaps just the person’s dialect, which we associate with unpleasant memories that have absolutely nothing to do with the current medical issues. But it is also possible that we were expecting to hear very concrete results in the consultation, and if the doctor cannot provide this – for whatever reason – we are disappointed, irrespective of whether or not this expectation was justified.

Scientists have long known that expectations can influence physical symptoms, the course of an illness and the success of a treatment: If a patient with a headache feels relief from taking a tablet, even before the active substance has entered the bloodstream, the effect may stem largely from the learned expectation that painkillers will relieve pain. Such knowledge gained from previous experience can activate the body's own “pharmacy” and thus alleviate symptoms. Scientists call this the placebo or expectation effect. And this sets off a cascade of reactions in the brain and body.

If a patient has already had negative experiences with a treatment, the expectation attached to the treatment can exert a negative impact, reducing the treatment’s success. For example, you might experience adverse side effects from a new medication because your neighbour told you he didn’t tolerate that medication well. This negative expectation ("I'm sure I'll have the same side effects!") provokes a so-called nocebo effect. This is precisely why it’s so important that you discuss your fears and concerns with your doctor. Only then, in a confidential and trusting conversation, can your doctor clear up any misunderstandings and reduce your fears. Please also read the following texts:

"How do I prepare for a visit to the doctor?"

"What a doctor needs know about me".

A patient who enters into treatment with faith and high hopes, by contrast, will be able to benefit more from the treatment than a patient who has low expectations. And if this positive expectation of effective treatment is combined with the care and attention of an empathetic doctor, the best possible outcome can be achieved.

It’s therefore important to listen to yourself in order to understand what expectations or even prejudices you take with you to the doctor (or a physiotherapist or psychotherapist, or any treatment provider), which you might use to judge them and their treatment suggestions. Only in this way is it possible to correct unhelpful expectations and reduce the negative influence of fears and worries, so that your treatment can benefit as much as possible from the effects of positive expectation and your body's own “pharmacy”.

Tell us your personal story involving the placebo effect! Medicine is also shaped by people’s stories. This is why we’re gathering patients’ diverse experiences regarding their own expectations for the Collaborative Research Centre "Treatment Expectation". You can find out more here.